Spinal tumours and metastases on the spinal column

Spinal tumours are growths on the spinal column. They can be benign or malignant and mainly occur in the spinal cord or vertebral bodies.

Spinal tumours can also develop in other parts of the spine, such as the nerve roots or the dura (spinal cord membrane). However, the majority of all spinal tumours are metastases derived from carcinomas that are outside the spine but have offshoots in the spine, or which have spread into the spine. The primary tumours may be located, for example, in the breast, in the prostate or lungs.

Spinal metastases occur in about 10 percent of all cancer patients. Men are more commonly affected than women.

Symptoms

The symptoms are very diverse. If the spinal metastases spread to the nerve roots and the cord of nerve tissue in the spinal canal, this may result in pain and impairments to certain motor and autonomic functions. The pain may be directly on the affected part of the spine (local pain) or nearby, for example in the chest or arms. When motor functions are restricted, the patient will experience reduced strength in the arms and legs. Paralysis can also occur.

Autonomic disorders include impotence, and issues with urination and bowel function. If the metastases causes pronounced compression of the spinal cord, these sensory disturbances may also cause numbness or discomfort.

Causes

About 50 percent of all spinal tumours are metastases and affect the vertebral body, which is made up of bone tissue. The metastases are associated with various cancers, especially of the kidney, breast, prostate or lung. With many primary spinal tumours, the cause is unclear.

Diagnosis

In order to be able to choose the right course of therapy, various physical examinations are carried out.

If more and more symptoms indicate spinal metastases, various diagnostic imaging procedures will be used to confirm the suspicion. With the aid of magnetic resonance imaging (MRI), it is possible to distinguish spinal metastases from other diseases. A computed tomography or CT scan provides a detailed overview of the bone structures. A contrast medium is used during the scan so that the tumour or metastases are easier to identify. After evaluating the results of the MRI or CT scan, it is possible to make a statement about the metastases and to establish a clinical picture.

Spinal tumours are divided into three groups:

  • intradural, intramedullary tumours – within the spinal cord
  • extradural tumours – on the vertebral bodies
  • intradural, extramedullary tumours – at the nerve roots

Unfortunately, metastases in the spine often go unnoticed until very late on because there are no symptoms in the early stages. Once diagnosed, prompt treatment is required to relieve the spinal cord.

Treatment

When treating spinal tumours and metastases, it is important to remove the structures affected by the cancer cells and to protect the spinal cord tissue and nerve roots as much as possible.

The type of treatment depends on the location and size of the tumour, or the metastases. Before surgery is carried out, various oncological and radio-oncological treatments are considered and, if necessary, executed. The aim of these preliminary treatments is to limit the growth of metastases or to shrink the tumour, for example.

Surgical intervention ranges from minimally invasive to maximally invasive. During the procedure, the function of the nerves and spinal cord are constantly monitored in order to prevent damage. If the position of the tumour is causing instability of the spine, special stabilisation systems are used.

Aftercare

Aftercare is decided on a case-by-case basis. One approach may focus on post-surgical rehabilitation, while another may be based on a series of oncological treatments and accompanying measures such as chemotherapy or radiation.

FAQs

What are the symptoms of metastases on the spine?

Patients complain of pain that occurs along the whole spine or just locally. This pain may be dull and extensive, but also acute and highly localised. Side effects such as paralysis or sensory disturbances may also occur.

How are spinal metastases diagnosed?

If metastases are suspected, various medical and radiological examinations are carried out. Magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide, among other things, the relevant evidence for determining the necessary course of treatment.

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